Original article
General thoracic
TNM Stage Is the Most Important Determinant of Survival in Metachronous Lung Cancer

Presented at the Poster Session of the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.
https://doi.org/10.1016/j.athoracsur.2009.06.098Get rights and content

Background

Distinguishing a metachronous lung cancer from a metastatic or recurrent lesion in patients with a prior history of non–small cell lung cancer is a challenging task. Previous studies have suggested histologic type and disease-free interval as criteria for diagnosing metachronous lung cancer. These factors may not be as relevant now that current imaging allows for earlier detection of tumors and with the rising incidence of adenocarcinoma. The purpose of this study was to reexamine the factors that determine outcomes in patients with a second primary lung cancer.

Methods

A retrospective review of a prospective lung cancer database was performed to identify patients with metachronous lung cancer. Metachronous lung cancer was defined as any non–small cell lung cancer occurring after a prior resection regardless of disease-free interval or histologic type. The Kaplan-Meier method was used for survival analysis. The Mantel-Cox method was used to compare overall survival. Cox regression was used for multivariate analysis.

Results

Fifty-eight patients had metachronous lung cancer. Overall survival at 5 years was 66% (stage IA, 74%; IB, 59%; all other stages, 0%; p = 0.01). Seventy-two percent (42 of 58 patients) had similar histologic type. There was no difference in overall survival based on similar versus different histologic type (65% versus 73%; p = 0.77). Median disease-free interval was 42 months (range, 8 to 312 months). Disease-free interval was not a significant predictor of overall survival (p = 0.24). The extent of resection included wedge (36%, 21 of 58 patients), segmentectomy (24%, 14 of 58 patients), and lobectomy (40%, 23 of 58 patients), with no difference in overall survival (58% versus 60% versus 75%, respectively; p = 0.32).

Conclusions

These data suggest that early tumor stage is the only significant determinant of survival after surgical treatment of metachronous lung cancer. Neither histologic type nor disease-free interval was of prognostic value. Limited resections may be adequate treatment.

Section snippets

Patients and Methods

The Thoracic Surgery Tumor Registry at the Weill Medical College of Cornell University served as the database. A retrospective review of this prospective database was used to identify patients with surgically resected MLC between 1995 and 2008.

After resection of the index primary cancer, all patients were followed according to our institutional guidelines, which included computed tomographic scans obtained postoperatively at 6 and 12 months, and annually thereafter [4, 5]. Metachronous lung

Results

From 1995 to 2008, 58 patients with surgically resected MLC were identified from a total of 1,900 patients who underwent pulmonary resection for NSCLC (3.1%). The median age at presentation of the MLC was 67 years (range, 48 to 86 years) and 35 of 58 (60%) were women (Table 1).

Comment

Approximately 35,000 patients in the United States undergo surgery for lung cancer each year, predominantly for early stage disease [7]. Historically, patients without lymph node metastases can be expected to have 5-year survival rates from 57% to 67% [1]. Recent reports indicate that 5-year survival for patients with stage IA cancer may even approach 80% [9, 10]. These patients are at significant risk to develop an MLC, with an incidence between 1% and 2% per patient, per year [2]. This risk

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